Objective:

To review the role of natural products as regulators of gut microbiota in atherosclerosis and their mechanisms of action.

Approach:

• Literature Review: Qualitative synthesis of English-language studies published from 2016 to 2026, focusing on natural products, gut microbiota, and atherosclerosis.

Key Findings:

• Naturalproductsmodulateatherosclerosisbyreshapinggutmicrobialecologyandmetabolicoutputs.Theyreducetrimethylamine/trimethylamineN-oxideproduction,promoteshort-chainfattyacidgeneration,remodelbileacidmetabolism,andmodulatemicrobialtryptophan-derivedmetabolites.Naturalproductsimproveintestinalbarrierintegrityandsuppressinflammationpathways.Polyphenolsandberberineshowedstrongermechanisticsupportcomparedtoothernaturalproducts.

Interpretation:

Natural products provide a framework for targeting the gut microbiota–metabolite–vascular pathology axis in atherosclerosis.

Limitations:

• Mostevidenceisderivedfromanimalandinvitrostudies.Clinicalstudiesarelimitedbysmallsamplesizes,shortfollow-upperiods,heterogeneousinterventions,surrogateendpoints,andinsufficientcausalvalidation.

Conclusion:

Further research is needed for standardized preparations, causal microbiome validation, multi-omics-based biomarkers, and well-designed clinical trials with vascular or cardiovascular endpoints.